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18 - Varicose veins and chronic venous insufficiency

Marcus Cleanthis
Freeman Hospital, UK
Tim Lees
Freeman Hospital, UK
Vish Bhattacharya
Queen Elizabeth Hospital
Gerard Stansby
Freeman Hospital
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Key points

  • Truncal varices are common with an age-adjusted prevalence of 40% in men and 32% in women

  • Varicosities may be primary or secondary due to previous deep vein thrombosis (DVT), pelvic obstruction or deep venous reflux

  • Patients present with discomfort, swelling, pain, pruritis, bleeding, thrombophlebitis and skin changes

  • Hand held Doppler has replaced the tourniquet test as a ‘bedside examination’ for evaluating incompetence of valves

  • Current treatments for varicose veins include conventional surgery, radiofrequency ablation, laser ablation and injection sclerotherapy (liquid or foam)

  • Surgery to the great saphenous vein involves high tie and stripping and has a recurrence rate of 15%–20%

  • Surgery to the small saphenous vein involves saphenopopliteal ligation, stripping and phlebectomy

  • Foam sclerotherapy and catheter ablation techniques using laser or radiofrequency can be used under local anaesthesia, but less is known about their long-term outcome

  • Chronic venous insufficiency affects between 7% and 9% of the adult population and is due to venous reflux, obstruction or calf pump failure

  • Clinical signs include swelling, venous eczema, pigmentation lipodermatosclerosis and ulceration

  • Multilayered compression is the gold standard used to heal venous ulceration

  • The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial showed a reduced ulcer recurrence rate with combined surgery and compression

  • Venous reconstruction is rarely performed and usually reserved for severe disease, resistant to other forms of treatment

Varicose veins


Data from the Edinburgh Vein Study suggest a slightly greater prevalence of varicose veins in males compared to females (4 : 3.2).

Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 204 - 219
Publisher: Cambridge University Press
Print publication year: 2011

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